B4 (Official Form 4) (12/07) United States Bankruptcy Court _______________ District Of ______________ In re ___________________________________, Debtor Case No. ___________________ Chapter ____________ LIST OF CREDITORS HOLDING 20 LARGEST UNSECURED CLAIMS Following is the list of the debtor’s creditors holding the 20 largest unsecured claims. The list is prepared in accordance with Fed. R. Bankr. P. 1007(d) for filing in this chapter 11 [or chapter 9] case. The list does not include (1) persons who come within the definition of “insider” set forth in 11 U.S.C. § 101, or (2) secured creditors unless the value of the collateral is such that the unsecured deficiency places the creditor among the holders of the 20 largest unsecured claims. If a minor child is one of the creditors holding the 20 largest unsecured claims, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). ______________________________________________________________________________ (1) (2) Name of creditor and complete mailing address, including zip code (3) Name, telephone number and Nature of claim complete mailing address, (trade debt, bank including zip code, of loan, government employee, agent, or department contract, etc.) of creditor familiar with claim who may be contacted (4) (5) Indicate if claim Amount of claim is contingent, [if secured also unliquidated, state value of disputed or security] subject to setoff __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Date: __________________________ _______________________________________ Debtor [Declaration as in Form 2] American LegalNet, Inc. www.FormsWorkflow.com